Journalists keep botching the story of health reform — here’s how they can get it right

After the Clinton health plan collapsed in 1994, I met a woman in the subway one day who talked about the failed effort. “Oh,” she said, “I didn’t understand a thing about it,” and that was after reading The New York Times and other publications. At first I felt wounded. What did she mean she didn’t understand the plan after all those millions of words that were written about it, some of which I wrote? As the years went on, I saw she was right. We reporters blew it. No wonder the public believed Harry and Louise, the TV ad couple sponsored by the health insurance industry that doomed health reform that year.

We blew it again in Round 2. Day after day as the Affordable Care Act was debated and reviled, I wrote for CJR that the public was being left behind in the debate, arguing again “the press is covering the process of reform, not the substance.” A few weeks before the Affordable Care became law, I summed up media coverage this way:

“Press coverage of the effort to reform health care has been largely incoherent to the man on the street. The 300 or so posts I have written about health care reform for CJR.org over the past two years tell the story of media coverage that failed to illuminate the crucial issues, quoted special interest groups and politicians without giving consumers enough information to judge if their claims were fact or fiction, did not dig deeply into the pros and cons of the proposals, and gave tons of ink and air time to the same handful of sources.”

Instead the media passed along the carefully crafted slogans from the Obama administration and its supporters. “If you like your plan, you can keep it” and “Affordable, quality health care for all” come to mind. When the public learned those claims weren’t always true, a fierce backlash dogged the health law for years, which never achieved the public acceptance its supporters had promised.

Round 3 of the health reform debate is upon us, as politicians and advocacy groups push new proposals for universal coverage. And once again we’re about to blow it judging from the media offerings to date. I’d wager, like in the past, the discussion is flying over the heads of the men and women on the street. So far, we are covering airy political slogans and the opposition to reform rather than the substance. In fairness, it’s hard to cover still-squishy legislation that has not yet been fleshed out, but such a critique is essential if reporters are to avoid the mistakes of the last two rounds of reform. 

There’s one key difference this time. The men and women on the street are much more receptive to big changes in their health insurance arrangements than they were in the two previous rounds. Witness the crowds that lashed out at Republican members of Congress in early 2017during their town hall meetings, vivid displays of displeasure at the thought of Americans losing health coverage. Maybe the Overton Window is at work — the range of politically acceptable policy ideas at any given moment. As The New York Times explained, the role of organizations may be to convince voters that policies outside the window should be in it. An unthinkable idea — “abolish private insurers!” “Medicare-for-all!” — can become so inevitable it’s hard to believe it was ever otherwise. The fringe can become normalized.

Andy Slavitt, who was the acting administrator of the Centers for Medicare and Medicaid Services under President Obama and now a prolific tweeter, summed up the public’s thinking this way:

“Americans have a highly aligned view on health care. They don’t want the government, insurance companies or judges to prevent them from getting it, affording it, or using it and they want the same for their neighbors.” 

Americans have a highly aligned view on health care. They don’t want the government, insurance companies or judges to prevent them from getting it, affording it, or using it and they want the same for their neighbors.

— Andy Slavitt (@ASlavitt) January 31, 2019

The part about Americans wanting the same for their neighbors is new. It’s the biggest shift in Americans’ acceptance of health care for others I’ve ever seen. But they don’t always know what policies will take them there. That’s why we need a press that will help connect the dots and put forth the options in honest and coherent ways. Right now, we’re far from that journalistic nirvana. Once again, many of the system’s stakeholders — hospitals, insurers, doctors and drug companies — all of whom could face significant disruption to their business model, are driving the discussion. The media are obliging them.

For instance, a week ago Robert Pear, the long-time health policy writer for The New York Times, penned what must a have been his umpteenth story about special interest groups trying to kill health reform legislation they didn’t like — in this case, Medicare-for-all. “We have a structure that frankly works for most Americans,” Charles Kahn III, the president of the Federation of American Hospitals, told Pear. “ … We reject the notion that we need to turn the whole apple cart over and start all over again.” Kahn has probably spoken similar words to the media many times over the last three decades.

So far, we are covering airy political slogans and the opposition to reform rather than the substance. In fairness, it’s hard to cover still-squishy legislation that has not yet been fleshed out, but such a critique is essential if reporters are to avoid the mistakes of the last two rounds of reform. 

The story piled on quote after quote echoing similar sentiments. “This is a slippery slope to government-run health care for every American,” added David Merritt, an executive vice president of the health insurers lobbying group (a group always vocal in preserving the status quo). The phrase is trotted out each time the debate veers in a direction that threatens the profits of health care’s special interests.

A few weeks before Pear’s story, Kimberly Leonard penned a similar piece for the Washington Examiner. She reported on the campaign of a new group, the Partnership for America’s Health Care Future, which is getting a lot of press of late. The group consists of big guns like Kahn’s hospital lobby but also the American Medical Association, Blue Cross insurers, commercial insurance companies, the pharmaceutical lobby PhRMA, biotech groups, and insurance agents. The Partnership “has launched a five-figure digital ad campaign arguing that ‘Medicare-for-all’ would cause massive disruption, higher taxes, lower quality care, and less choice for patients.”

There will be more such stories that help the special interests get their messages out. These stories shouldn’t just parrot the talking points of special interests without also explaining how their proposals would affect ordinary citizens who continue to suffer in today’s unaffordable system. Think of the uncertainty arising from surprise medical bills that can hit anyone, insured or not. The thousands of dollars in cost-sharing deductibles and coinsurance extracted by insurers and employers to lower their costs. The fight for approvals and insurer roadblocks to get needed treatments, and medicines that more and more Americans cannot afford. 

So what’s a reporter tasked with covering Round 3 in an otherwise rigged fight supposed to do? I offer a few suggestions:

Beware the memes of the day. The biggest one at the moment is that proposals for universal coverage are too expensive, costing trillions of dollars the country can’t afford. “I think we could never afford that,” says former New York City Mayor Michael Bloomberg. Replacing the entire private system “would bankrupt us for a very long time.” Former Starbucks chief executive and possible presidential candidate Howard Schultz said the same thing, and his quote makes news without analysis.

In a well-argued column, however, Paul Waldman, an opinion writer for the Washington Post’s Plum Line blog points out that so far the media have botched coverage of the cost of universal coverage. Waldman notes that one can oppose universal coverage for several reasons, but “what you cannot say is that a universal system is unaffordable. You have to compare what a universal system would cost to what we’re paying now.” If we keep the system we have now, Waldman argues, we’ll spend $50 trillion over the next decade, which pushes us close to spending 20 percent of our GDP on health care.

In short, trotting out scary quotes about the astronomical costs of universal coverage while ignoring the astronomical costs of today’s system left unchanged is bad journalism.

A few other developing memes deserve further scrutiny. How relevant is it to audiences that Medicare-for-all bills have fewer sponsors than in the past? Is it to throw cold water on the idea, or to fill space or airtime without more explanation of how such a plan might work? Inside baseball stories always carry an opportunity cost.

Another developing meme is that the system is working fine for most people. No big fixes needed here. Before passing along those claims, which are talking points of groups opposing disruption to their business practices, pin the special interest spokespeople down on how exactly they would fix the ills now plaguing the system. And then investigate how viable politically those repairs really are. In other words, do some “compare and contrast.” 

Beware of sponsored content. In the previous rounds of reform, sponsored content — advertising copy that mimics legitimate news copy — was not a trap to trip up reporters. It is today. Some special interests opposing reform have taken to outlets such as Politico to send out their messages, some of which come very close to mimicking legitimate stories. The headlines look similar, the typeface is similar, and they are easy for a reader to mistake it for a piece by the outlet’s own reporters. A case in point are two newsletters published in November by Politico New York that are sponsored by Realities of Single Payer, a New York-based group comprised of business groups, health insurance sales people, insurance organizations and physician professional groups. In copy that’s remarkably similar to the newsletter’s regular tidbits, readers learn single payer is a “disaster” and puts “control of your health care into the hands of unaccountable Albany bureaucrats.” In small type with an asterisk, Politico discloses the copy is a message from Realities of Single Payer. Nevertheless, statements like that merit some serious reportorial analysis. So far, Politico New York has offered none, according to health reporter Dan Goldberg. Coincidence?  

Investigate who is funding supporters and opponents of various measures. It may be that campaign contributions aren’t worth discussing anymore. Are reporters and the public are so accustomed to special interests giving gobs of money to buy access to members of Congress that good reporting doesn’t even mention it any more? It should. If drug and device makers have given lots of money to certain key Congress members, that says a lot about what they may expect from those members. Such contributions are readily available on OpenSecrets.org. 

Let’s face it. Journalists and the public love a good horse race, and it’s easy to fall into the trap of horserace coverage, as we have during the previous runs at reform. Does Clinton Lite have a chance? Is the public option political suicide? As The Washington Post’s Waldman points out, right now the debate is wrongly being framed as “a disagreement between a bunch of Democrats peddling pie-in-the-sky notions and more hardheaded and realistic critics (not limited to Republicans) asking the tough questions about affordability.”

It’s much more than that. It’s the latest chapter in a decades-old struggle to make American health care more equitable, a master storyline that all those covering this latest round of partisan warfare and special interest fusillades should keep in mind. 

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.